What is the treatment for Vibrio vulnificusinfection?

What is the outcome of Vibrio vulnificusinfection?

The outcome of V. vulnificusinfection is usually good with prompt treatment. However, the infection may be fatal in up to 50% of patients with pre-existing liver disease. It has been recommended that patients with liver disease do not eat raw shellfish.

Mercury poisoning due to fish ingestion

What causes mercury poisoning?

Mercury poisoning is due to the ingestion of mercury, including mercury in fish. In New Zealand, high mercury levels are found in the following species of fish:

Cardinalfish

Dogfish (excluding rig shark)

Lake Rotomahana trout

Lake trout from geothermal regions

School shark (greyboy or tope)

Striped marlin

Southern bluefin tuna

Swordfish.

What are the clinical features of mercury poisoning?

The clinical features of mercury poisoning tend to occur weeks to months after acuteingestion. Symptoms may include:

Tiredness

Loss of appetite

Light sensitivity

Generalised weakness

Painful extremities

Tremor

Changes in mood.

Skin signs may include colour changes in the hands and feet, with associated pain and itch. Hair loss and nail loss has been described. Excessive sweating and inflammation of the gums may also occur.

What are the complications of mercury poisoning?

Complications from mercury poisoning include pain and colour change in the extremities and permanent loss of teeth resulting from gum inflammation. Hair and nail loss may be slow to resolve.

If the mercury poisoning is severe, patients may develop acuterenal failure.

How is mercury poisoning diagnosed?

Mercury poisoning can be diagnosed from measuring levels of mercury in the blood.

What is the differential diagnosis for mercury poisoning?

The differential diagnosis for mercury poisoning is broad, as symptoms may be nonspecific. It may include:

What is the treatment for mercury poisoning?

The treatment of mercury poisoning includes supportive care, such as correcting any fluid and electrolyte imbalances. Chelation with meso 2,3-dimercaptosuccinic acid may be used to prevent methylmercury uptake by erythrocytes (red blood cells) and hepatocytes (liver cells).

It is essential to avoid further exposure to mercury. Avoid eating the fish species mentioned above. Be aware that various herbal and traditional remedies may also contain mercury.

What is the outcome of mercury poisoning?

The signs and symptoms of mercury poisoning gradually disappear once treatment is started, providing there is no further ingestion.

Acute vitamin A toxicity due to ingestion of fish

What causes acute vitamin A toxicity?

Acutevitamin A toxicity is caused by the ingestion of too much vitamin A. There are high levels of vitamin A in the liver of various fish species, including:

Ocean perch

Reef or tropical fish in Bermuda (these may not be carnivorous species)

What are the clinical features of acute vitamin A toxicity?

Acute vitamin A toxicity results in redness of the skin, followed by desquamation, dryness, peeling of the lips, and dry eyes. Hair loss and nail thinning or loss may become apparent after some weeks.

Other features of vitamin A toxicity include headache, abdominal pain, nausea, and vomiting.

What are the complications of vitamin A toxicity?

A severe overdose of vitamin A can lead to death. The intake of high levels of vitamin A or other retinoids during pregnancy has been associated with birth defects.

How is vitamin A toxicity diagnosed?

The diagnosis of vitamin A toxicity is based on the patient’s signs and symptoms, and a history of the ingestion of vitamin A or a retinoid. There is a poor correlation between toxicity and serum retinol levels, as vitamin A is rapidly metabolised to retinoic acid. Blood samples must be stored in the dark before analysis.

What is the differential diagnosis of vitamin A toxicity?

The differential diagnosis for vitamin A toxicity is broad, as symptoms may be nonspecific. When symptoms are associated with the ingestion of fish, consider:

Mercury poisoning

Scombroid fish poisoning (if the onset of symptoms is acute).

What is the treatment for vitamin A toxicity?

The source of the vitamin A toxicity should be avoided, including fish and various supplements, and herbal or traditional remedies containing vitamin A.

Vitamin A will be processed by the body over time. Fluid and electrolyte abnormalities due to vomiting should be corrected.

What is the outcome of vitamin A toxicity?

The outcome of vitamin A toxicity is good. Skin peeling settles over a few weeks as new skin cells are generated.